Organization
OPTIMAL PERFORMANCE HEALTH CARE CENTER LLC
Active
Organization
OPTIMAL PERFORMANCE HEALTH CARE CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. COREY VAN WESTEN D.C. (OWNER/CLINIC DIRECTOR)
(414) 491-8650
Entity
Organization
Contact information
Practice address
10500 W LOOMIS RD, SUITE 160, FRANKLIN, WI 53132-8030
(414) 491-8650
(414) 810-0894
Mailing address
1962 N COMMERCE ST, MILWAUKEE, WI 53212-3401
(414) 491-8650
Taxonomy
Speciality
Code
Description
License number
State
111NR0400X
Rehabilitation Chiropractor
Primary
4410-12
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100002627
—
WI
01
—
1275814345
GROUP NPI
WI
01
—
1588628473
INDIVIDUAL NPI
WI
Enumeration date
09/02/2011
Last updated
09/23/2011
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